Journal of Psychiatric and Mental Health Nursing , 2002, 9, 87–94

Blackwell Science, LtdOxford, UK

JPMJournal of Psychiatric and Mental Health Nursing1351-0126Blackwell Science Ltd, 2001
86December 2001
449
Othering and psychiatric nursing
E. J. MacCallum
10.1046/j.1351-0126.2001.00449.x
Original ArticleBEES SGML

Othering and psychiatric nursing

E. J. MACCALLUM bsc(hons) rn(mental health)
Scottish Development Centre for Mental Health, 17a Graham Street, Edinburgh, UK

Correspondence: MACCALLUM E. J. (2002) Journal of Psychiatric and Mental Health Nursing 9, 87–94
E.J. MacCallum Othering and psychiatric nursing
Scottish Development Centre for
Mental Health
This paper is a theoretical exploration of the concept of Othering in relation to psychi-
17a Graham Street
atric nursing. The concept of Othering is examined by working the dualisms of same/
Edinburgh
other in relation to the dualisms of east/west, man/woman and reason/unreason. Oth-
EH6 5QN
UK
ering is also examined in relation to the construction of knowledge and reality. The role
of psychiatry and implications for nursing practice are discussed. Othering is found to be
a complex problem which is an inevitability of nursing practice. Possible solutions to the
problem of Othering are presented.

Keywords: difference, Othering, psychiatric nursing, reality, social knowledge, us and

them

Accepted for publication: 20 November 2000

Accepted for publication : 30 July 2001

will be paid to the role of psychiatry in Othering and the

Introduction implications for nursing practice.
This paper is essentially a theoretical exploration of Oth-
ering and its relevance to nursing practice. The paper is
What is Othering?
therefore situated ‘on the edge’ of theory and practice. The
Other I am interested in is the people who are diagnosed as Some would say that Othering has always existed and is an
‘mentally ill’. My aim is to show how the theoretical prob- intrinsic aspect of human consciousness:
lem of Othering is practically relevant. The category of the Other is as primordial as
Othering is part of the process of talking and writing consciousness itself. In the most primitive societies, in
about patients. However, it is necessary for nurses to talk the most ancient mythologies, one finds the expression
and write about the patients in their care during the course of a duality – that of the Self and the Other (de Beauvoir
of their work. I do not suggest they do not. Rather, I sug- 1972, p. 16).
gest that nurses should consider the effects of these activi- Kitzinger & Wilkinson (1996, p. 8) provide a useful
ties. As nurses we need to recognize difference, and work definition of Othering:
across difference rather than perpetuate it. Who and what Others are . . . is intimately related to
In my exploration of Othering I will attempt to define ‘our’ notion of who and what ‘we’ are. ‘We’ use Other
what Othering is and examine related concepts. I will also to define ourselves: ‘we’ understand ourselves in relation
explore the dualism of same/other in relation to the dual- to what we are not.
isms of east/west, man/woman and reason/unreason before A group is defined not necessarily by those who are in it
examining Othering in relation to the construction of but by those who are excluded from it.
knowledge and the construction of reality. Special attention We forget that the outsiders are part of our definition of
ourselves. To confirm our own identity we push the
outsiders even further away. By reducing their humanity
The Scottish Development Centre for Mental Health is part of the we emphasize our own (Littlewood & Lipsedge 1997, p.
Institute of Applied Health and Social Policy, King’s College London 27).

© 2002 Blackwell Science Ltd 87

E. J. MacCallum
Concepts related to Othering
Difference
Our understanding of Other is important for how we
understand difference. It is easy to use Otherness and dif-
ference synonymously but they must be kept separate
because it is not helpful to our understanding to merge the
two. As Carabine (1996) points out, not all differences are
the same. The difference between the One and the Other,
or Self and Other, is oppositional difference rather than
difference as diversity. The Other is attributed a negative
value, and the Same a positive value. The concept of Other
is deeply implicated in power relations (Carabine 1996).
For example, the creation of Others in social sciences
involves the privileged researching and representing poor
people, mentally ill people and other groups who are pow-
erless in relation to the researchers (Brown 1996).
Us and Them
The ‘Us’ and ‘Them’ phenomenon is an example of Oth-
ering. ‘Them’ are posited as ‘Other’, of less value than ‘Us’.
‘Us’ defines ‘Them’. People do not position themselves as
Other, or as ‘Them’. Once positioned as Other some people
may seek to maintain and celebrate their Otherness, e.g.
Mad Pride.
I became interested in the topic, which I now construe as
Othering, during a placement as a student nurse on a psy-
chiatric inpatient ward. I found there to be a culture of ‘Us’
and ‘Them’, staff and patients, who inhabited two very dif-
ferent worlds. I was caught in between the two worlds of
the staff and the patients, neither belonging to ‘Us’ nor to
‘Them’. It was this experience that led me to explore Oth-
ering in the literature.
Davidson (1998) writes of his experience as a student
psychiatric nurse and describes reassurance given to a stu-
dent. The reassurance served to invite the student to share
the attitude of the staff group. Shared attitudes contributed
to staff bonding and provided the staff group with cohe-
sion. Once established, the bond was maintained by
‘oppressive suspicion’ of the patients. Davidson (1998) felt
caught between the staff world and the patient world.
Rudman (1996, p. 42) ponders:
To what extent do we maintain professional power and
distance to prove the other person is irrational or sick,
and thus maintain our own sense of integrity and sanity?
The ‘Us’ and ‘Them’ mentality that exists in psychiatric
care maintains patients as Other, mentally ill, and reasserts
the staff’s ‘sanity’ and also, their power.
Hart (1997) raises the issue of the ‘Us’ and ‘Them’ atti-
tude from the perspective as a patient and also as a mental
88 © 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
health worker. She considered that it was problematic for
the staff to care for a person who was both an ‘Us’ and a
‘Them’.
Dualisms – working the distinction
Our understanding of the dualism of the ‘Self and the
Other’ can be explored further in relation to the dualisms
of west/east, man/woman, reason/unreason. Working these
dualisms helps cast further light on the dualism of same/
other. Othering is essentially about constructing dualisms.
Woman is described in relation to man; the insane are
defined in relation to the sane.
Othering is often discussed in terms of gender and race,
i.e. woman as Other, black person as Other. I wish to
explore the construction of people with mental illness as
Other. This contains a different aspect from the discourses
of race and gender, as mental illness is a category that peo-
ple can move in and out of, that is, it is fluid, not fixed. It
is also interesting to note that the dualism of reason/unrea-
son is focussed on reason itself. It is an act of reason to split
reason from unreason. Conversely, it is an act of unreason
to be unable to do this and this is sometimes referred to as
‘lack of insight’.
Duality of West/East – Orientalism
Colonialism created Others (Kitzinger & Wilkinson 1996).
According to Littlewood & Lipsedge (1997) there are two
types of outsiders: the mentally ill and non-Europeans. Said
(1978) problematizes this process of Othering, which, he
says, goes on. He describes the Orient as:
The place of Europe’s greatest and richest and oldest
colonies, the source of its civilisations and languages, its
cultural contestand, and one of its deepest and most
recurring images of the Other (Said 1978, p. 1).
This description immediately sets up the distinction
between East and West. The West had the power to define
the East as the Other. East and West may mean ‘Them’ in
the East and ‘Us’ in the West. Said (1978, p. 3) informs us
that ‘European culture gained in strength and identity by
setting itself off against the Orient.’ Therefore, in defining
the East, Orientalists were taking part in an exercise that
was essentially about defining the West. Orientalism is a
subject that which teaches more about European power
over the Orient than it informs about the Orient (Said
1978). Therefore, in representing the Orient, the European
representer conveys more about what it is to be European
than what it is to be Oriental. This is evidence of the posi-
tional superiority of Europeans and cultural domination.
The Orient is positioned as Other. What is more, posi-
tioned as Other, the Orient is silenced, disallowed to

describe the Orient. As Other, their words are powerless
and meaningless. ‘. . . Only the Orientalist can interpret the
Orient, the Orient being radically incapable of interpreting
itself’ (Said 1978, p. 289).
A comparison may be made with this last statement and
the situation of psychiatric patients. It could be said that
only the psychiatrist or psychiatric nurse can interpret the
mentally ill. Representations of the mentally ill appear in
medical and nursing notes, the notes of other professionals
involved in their care and in the representations of writers
and researchers. The mentally ill have been assumed to be
incapable of interpreting themselves and speaking for
themselves. Unable to recognize the truth of their being,
their condition, the mentally ill are said to ‘lack insight’.
This implies that the mentally ill are doubly irrational; they
are irrational because they are mentally ill and they are
doubly irrational because they are mentally ill and they
don’t recognize it.
Duality of man/woman
The concept of the Other has been discussed in relation to
woman as Other and can be found in feminist discourse. de
Beauvoir (1972) makes the point that Others do not define
themselves as Other, rather it is the person with power who
sets himself up as the One by defining the Other. Men
define women as Other in the same way that psychiatrists
define the mentally ill as Other.
Constructed as Other, women are relegated to the
position of mere objects of male knowledge and our
own knowledge and experience are routinely obliterated
(Kitzinger & Wilkinson 1996, p. 4).
Constructing people as mentally ill positions them as
Others and relegates them to the position of passive objects
of psychiatric knowledge and their own knowledge and
experiences are routinely obliterated.
The powerful patriarchal and medical discourses subju-
gate the less powerful knowledge of women and of ethnic
minority groups (Coyle 1999). According to Ussher
(1991), misogyny makes women mad through naming
women as the Other or by depriving women of power. Or,
misogyny causes women to be named as mad and thereby
silences women’s voice. ‘For madness acts as a signifier,
clearly positioning women as the Other’ (Ussher 1991, p.
11).
Historically, the mentally ill were considered to be
witches. In reality, and in imagination, witch equals
woman therefore women were mentally ill (Ussher 1991).
Szasz (1971, cited by Ussher 1991, p. 55) suggests that
‘witchcraft and mental illness are imprecise and all-
encompassing concepts, freely acceptable to whatever uses
the priest or physician (or lay “diagnostician”) wishes to
© 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
Othering and psychiatric nursing
put them’. In this context, ‘Other’ can be seen to be a vague
residual category.
The dualism of mind/body is essentially a Western con-
struction. The labelling of women as mad continued into
the Victorian era and, at that time, women were confined
to the home (Ussher 1991). Also, at that time science began
to dominate and had the power to define reality. Madness
became synonymous with femininity even when experi-
enced by men. This can be explained by the dualisms that
characterise Western thought (Longhurst 1997). Feminists
argue that this dualism is gendered; male characteristics are
associated with the mind and female characteristics with
the body. Mind is privileged over body. Men are thought to
be rational, able to transcend their bodies, reason and this
allows them to ‘speak universal knowledge’ (Longhurst
1997, p. 491). Women are associated with their reproduc-
tive body, tied to nature and the instincts, rhythms, desires
of their body, incapable of rationality (Longhurst 1997).
Rationality identifies masculinity and, conversely, feminin-
ity is associated with the non-rational, hysterical, Other.
So, even when men experience madness it is associated with
femininity. Men are rational; women are not.
The focus on women’s sexuality and menstruation was
such that evil and madness also became synonymous in the
literature of the nineteenth century. Mad women were
incarcerated in asylums or ‘inside their own “weak and
afflicted” bodies, which were treated with leeching, solitary
confinement, clitoridectomy, frequent intercourse, or a
good beating from a “concerned” husband’ (Ussher
1991, p. 88). From the time of witches to the Victorian era,
the discourse of madness changed and, hence, the language
used changed but madness remained a problem of women.
This represents the loss of power of the churches to science,
which had become equated with the truth. ‘Much of the
therapeutic discourse is still tied to science, and thus to
power, to prestige and to patriarchy’ (Ussher 1991, p. 109).
Madness is a label to mark as Other and prevents challeng-
ing the One (Ussher 1991). The account of the labelling of
women as mad in the time of witch hunts and the Victorian
era, and the ‘treatment’ for women’s madness, reveals as
much, if not more, about male fantasies and perversions
than it does about women’s madness. Othering is unin-
tended by those constructing women as witches, as mad. It
is only by standing back that this can be seen. An important
aspect of Othering is that it is not considered as such.
Those writing about the mentally ill, do not intend that
what they write reveals as much about them:
Accounts of the social world, no matter how much they
are animated by a sincere desire for truth, are never
more than stories we tell whose themes and meanings
express the social positioning of the story teller
(Seidman 1994, p. 117).
89
E. J. MacCallum
Similarly, the position of the writer is expressed in
accounts of patients written by psychiatrists, nurses or
others involved in their care.
Dualism of reason/unreason
The dualism of reason/unreason can be explored through a
Foucauldian discussion of psychiatry. This is relevant to
psychiatric nursing, as psychiatric nurses generally care for
those whose ‘unreason’ results in them being segregated
from society and named as Other, diagnosed as mentally ill
by psychiatrists. Psychiatry performs a powerful social con-
trol function. Part of Foucault’s work has been the study of
‘dividing practices’. ‘The subject is either divided inside
himself or divided from others. This process objectivises
him’ (Foucault 1982). As an example of this, Foucault pre-
sents the division of the mad and the sane. To understand
the dualism of reason and unreason we need to understand
the ‘cultural production of the rational as a “good thing”
and the irrational as something which needs not only to be
excluded but also to be rigorously policed’ (Parker et al.
1995).
Psychiatry is the profession with the claims to knowl-
edge and science that has charge of the social control of the
mentally ill. ‘Two words sum up everything: power and
knowledge’ (Foucault 1981, p. 293). Foucault (1981, p.
293) asks the rhetorical question: ‘Cannot the intertwining
of the effects of power and knowledge be grasped in the
case of a science as contestable as psychiatry?’ In Madness
and Civilization, Foucault charts the Great Confinement.
From the time of the Enlightenment onwards there
emerged a spirit of capitalism, which promoted rationality.
Reason became separated from unreason, and madness
was viewed as a lack of reason. Foucault calls the period
when the segregation of the mad took place (1650–1789),
the ‘Age of Reason’. This is when madness was excluded
from society in the Great Confinement. The mad and the
‘socially useless’ were segregated into an ‘other world’
(Foucault 1986).
Shared Otherness
Karla Boyce (1998) reflects on her experience as a black
woman and a psychiatric nurse and provides an example
of shared Otherness where she identifies herself as more
alike than different from someone constructed as the
Other. Boyce (1998) highlighted the difficulty of retaining
her sense of being in a system that expected her to conform
to the dominant culture. Boyce (1998) presents a case
study of the care given to a black Afro-Caribbean woman
whose behaviour was interpreted as madness, rather than
being understood as frustration at being secluded, not
90 © 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
communicated with. Boyce (1998) was prevented from
using her knowledge of what it means to be black in a
white institution to engage with the patient. She related to
the patient as a black person and as a woman and on those
accounts she recognized a shared Otherness as defined by
the institution. However, she was considered sane, and
therefore the ‘same’ as staff, and this was used to position
her against the patient. Therefore, to different people, in
different contexts, different things mark a person as
‘Other’. In this situation the staff considered her as one of
them, when she may have related more closely with the
patient. By not allowing her to use her knowledge of what
it is to be a black woman in a white institution the staff,
and the institution, disregarded fundamental aspects of her
being.
Mental health nurses need to make a commitment to
recognising difference and accepting alternative and
competing cultural values in the course of their practice,
despite pressure to homogenise care (Walsh 1997, p.
173).
Walsh writes from experience of working in New
Zealand as a psychiatric nurse. In her work with Maori
people she stresses that it is important to acknowledge cul-
tural differences and the power structures between her and
them (Walsh 1997). ‘Central to human interaction is the
idea of locating the “other” ’ (Weedon cited by Walsh
1997). We locate the Other in order to define our bound-
aries. When a person is mentally ill they need help to locate
the boundaries. If a person is mentally ill and considered
‘different’ they need skilled intervention to help identify
who they are and who others are (Walsh 1997).
Lyth (1988) suggests that a close relationship between
patient and nurse is likely to cause anxiety in the nurse.
This results in the inhibition of the ‘development of a full
person-to-person relationship between nurse and patient,
with its consequent anxiety’ (Lyth 1988, p. 52). Devices
to inhibit the development of a full person-to-person
relationship operate structurally and culturally. Lyth
(1988, p. 52) states that ‘there is an almost explicit
“ethic” that any patient must be the same as any other
patient’; therefore, it should not matter to the nurse who
she nurses and conversely it should not matter to the
patient who nurses them. If we follow this argument to
its logical conclusion, it is necessary to construct patients
as Other in order for the nurse to nurse without suffer-
ing from the anxiety of emotional involvement in the
nurse–patient relationship. This contradicts Barker’s argu-
ment that nurses need to be emotionally involved to nurse
the patient (Barker 1991).
Barker et al. (1998) discuss the ‘Us’ and ‘Them’ mental-
ity, recognizing the distinction made between ‘Us’ (men-
tally healthy) and ‘Them’ (mentally ill). They suggest that if

mental health professionals believe that those with mental
health problems and those without can be easily distin-
guished, they are failing to recognize their own wounds.
Othering and knowledge
Construction of Others through the construction of
social knowledge
Seidman (1994) charts the progress of social theory from
the time of the enlightenment to the present. The Enlight-
eners pioneered the new science of society, breaking away
from Roman and Christian traditions of social thought,
with their belief that true knowledge can only rest on sci-
entific method. Humans create society and form a world of
institutions that shape us. By breaking away from Roman
and Christian traditions of social thought, reason could
triumph over prejudice, and science was wedded to liberal
humanistic world views. Seidman (1994) questions whe-
ther science today remains wedded to liberal humanistic
world views, citing evidence of scientific abuse and control
through medicine and psychiatry (Seidman 1994). An
example of this comes from the former USSR where polit-
ical dissidents were forcibly detained and ‘treated’ in psy-
chiatric hospitals in an attempt to maintain political
control by claiming it was the individual’s psyche that was
in need of repair and not the political system (Adler &
Gluzman 1993). This example illustrates that people can be
categorized as Other to prevent them challenging the dom-
inant social order.
Othering in the production of knowledge
Sociology became institutionalized as white, male and mid-
dle class and this served to exclude perspectives that were
threatening to this dominant body of knowledge (Seidman
1994). Dorothy E. Smith has challenged the absence of
women’s perspective in sociology. Smith (1988) claims that
women have been excluded from the making of knowledge
and that women’s experiences and ways of knowing have
not been represented. The reason for this is that men have
written history with their interests in mind, and women
have been excluded from ‘participating in creating the cul-
ture of society’. ‘Its general culture is not ours’, i.e. it is
men’s, not women’s (Smith 1988, p. 36). This is because,
historically, the opinions of women have not had an arena
in which their opinions could be heard (Smith 1988).
Othering and the social construction of reality
‘The sociology of knowledge is concerned with the analysis
of the social construction of reality’ (Berger & Luckman
© 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
Othering and psychiatric nursing
1996, p. 15). This text conveys the understanding that
most people in society do not theorize, but rather that they
live in a world; therefore the sociology of knowledge must
concern itself ‘with what people “know” as “reality” in
their everyday, non- or pre-theoretical lives’ (Berger &
Luckman 1996, p. 27). This notion places importance on
the lay perspective and is concerned with understanding
reality as it is experienced. The lay perspective is common-
sense knowledge. Berger and Luckman ‘approached social
life as produced and reproduced in individual interaction’
(Seidman 1994, p. 128). Individuals are socially con-
structed through interaction; a requirement of self-
consciousness is the presence of an ‘other’ (Gerber 1997).
Implications for practice
Othering steals the voice of the person/people constructed
as Other. Talking and writing about the Other steals the
authority of their lives. Nurses, in the course of their work,
talk about and write about their observations and interpre-
tations of patients.
Talking with the Other
Madness transcends the boundaries of the reality of every-
day life: it points to a different reality (Berger & Luckman
1996). Tilley (1995) claims that psychiatric nurses’ work
involves ‘reality maintenance’. This involves talking of
ordinary things in which nurses and patients share/con-
struct the same reality (Tilley 1995). The terms that nurses
and patients use reveal distinctions in the social reality
meaningful to them. Tilley’s (1995, p. 169) stance is that
‘differences in knowledge constituted differences in reality’.
Nurses claim that their reality makes sense and they expect
patients to ‘come round’ to their claims of reality (Tilley
1995). For example, if a patient holds different understand-
ings from the nurses, he is said to ‘lack insight’. Tilley
(1995, p. 216) has ‘argued that the differences between
nurses’ and patients’ knowledge provided the occasions for
assessment and treatment intended to restore the patient to
common sense.’ Peplau (cited by Tilley 1999), writing
about nurse–patient interaction, said that:
The interaction of nurse and patient is fruitful when a
method of communication that identifies and uses
common meanings is at work in the situation.
If by common meanings we mean common sense, then
Altschul disagrees with this basis of interaction. In Alts-
chul’s discourse ‘common sense was constructed as an
inadequately accountable basis for practice’ (Tilley
1999, p. 23). Rather, Altschul’s discourse values theoretical
knowledge, while common sense is considered a ‘residual
category’ of knowledge (Tilley 1999).
91
E. J. MacCallum
Writing the Other
Research and knowledge have limitations. ‘All representa-
tions are embedded first in the language and then in the cul-
ture, institutions, and political ambience of the representer’
(Said 1978, p. 272). There is a case to argue that qualitative
research texts can be compared with nursing notes that are
written about patients. The policy of open access to nursing
notes permits the patient to read what has been written.
However, this does little to address what the patient may
believe to be misrepresentation unless the patient is permit-
ted to contribute to the notes. Opie (1992) is concerned
with ‘the control of interpretation’. In qualitative research
it has become practice to give research participants a copy
of the written report and to ask for their comments (Opie
1992). Opie (1992) suggests it is unclear how the final ver-
sion is reached. Similarly, with open access nursing notes it
is unclear as to whose version is represented when there is
disagreement.
Parkes (1999) acknowledges that what is written about
Others often reiterates and reinforces what has been writ-
ten before.
Othering and psychiatry
Ussher (1991, p. 140) provides a useful definition of Oth-
ering in psychiatry:
Outsiders and aliens maintain the cohesion of social
groups and play an important part in defining the
identity of the in-group, defining what is normal
behaviour. The ‘Other’ is needed to define the ‘One’.
Through defining what is mad, we denote what is sane,
what is ‘normal’, a process carried out by psychiatrists
and other social control experts, who negotiate reality
on behalf of the rest of society.
Foucault did research work at Hôpital Saint Anne in
France and in observation he ‘felt very close to and not
very different from the inmates’ (Miller 1994, p. 62). Fou-
cault observed ‘the man of madness and the man of rea-
son’ though ‘moving apart are not yet disjunct’ (Miller
1994, p. 106). The central argument of Madness and Civ-
ilization is that ‘Madness only exists in society’ (Miller
1994, p. 98). It is an invention, a product of social rela-
tions (Miller 1994). Foucault’s stance can be compared
with Said’s (1978) work on Orientalism where the West
only exists in relation to the East. We need to redirect the
focus from the mad to the cultures, institutions and lan-
guage practices that make it an issue (Parker et al. 1995).
It is practices of power that hold the oppositions of sane/
insane in place. According to Foucault, we live with an
ingrained predisposition to view madness as essentially
‘other’ (Pilgrim & Rogers 1993).
92 © 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
The sociology of deviance and labelling theory as
related to Othering in psychiatry
In order to understand the process by which a person
becomes the mad Other, it is useful to look at the sociology
of deviance and labelling theory. A complex web of social
rules constructs society. A person who breaks those rules is
considered deviant, Other. Those who respond to a differ-
ent reality from the ‘reality of everyday life’ may transgress
social rules and be considered deviant. ‘Social groups create
deviance by making the rules whose infraction constitutes
deviance’ (Becker 1963, p. 9). The rules are not always
clear and it may not be until they have been broken that we
are aware of their existence. Deviant behaviour can be said
to be a social construct. Whether behaviour is regarded as
deviant is dependent upon the social context in which that
behaviour is exhibited.
Some people think deviance is a product of mental ill-
ness (Becker 1963). Other people think mental illness is a
label for deviance. Ussher (1991) argues that deviance has
been medicalized for social control purposes. A psychiatric
diagnosis is a label to deviancy (Ussher 1991). If mental ill-
ness is a label to deviancy, and deviancy is dependent on
social rules, then mental illness must similarly be dependent
on social rules and, as such, cannot be diagnosed by scien-
tific objectivity.
It is psychiatry’s claim to scientific knowledge that places
psychiatry, as a profession, in power. Labelling can be seen
as a practice of power. The sociology of deviance implies
that psychiatric power is based on false claims.
Gomm (1996) proposes that the labelling of deviant
behaviour as mental illness reflects the interests of psychi-
atrists and mental health professionals because labelling
people as mentally ill creates work for them. The label
overrides a person’s status in other areas, for example, par-
ent, partner, employee, friend and, once labelled, the per-
son may be rejected by family and friends (Becker 1963).
Those labelled as ‘mentally ill’ become part of a deviant
subgroup (Ussher 1991). The group is homogenized, yet
the only thing they may share in common is the label (Per-
kins & Repper 1998). This scapegoats the outsider and
maintains the evidence of the Other (Ussher 1991).
Scheff (1996) suggests that stereotypes of mental illness
are learned early in life and that these stereotypes are con-
tinually reaffirmed in ordinary social interaction. By per-
mitting a person labelled mentally ill to behave in ways
that conform to stereotyped notions of mental illness, the
person is maintained at a distance and is constructed as
Other.
Rosenhan’s (1996) well-known study of eight sane peo-
ple who gained admission to 12 different psychiatric hos-
pitals demonstrates the power of labelling. When they were

eventually discharged, it was with a diagnosis of schizo-
phrenia ‘in remission’, not as sane people. This experiment
showed how unreliable the diagnostic process is and that,
once labelled, the schizophrenic cannot overcome the label.
The label ‘colors others perceptions of him and his behav-
iour’ (Rosenhan 1996, p. 75). An example of this is that the
pseudopatients openly wrote their research notes on the
ward and this was documented as ‘patient engages in writ-
ing behaviour’ (Rosenhan 1996).
Working with ‘Others’
Often, Self and Other are presented as discrete categories,
oppositions. Fine (1994, p. 72) suggests that ‘Self and
Other are knottily entangled’ and proposes that those rep-
resenting Others ‘work the hyphen’. That is, to explore
the relation between Self and Other and work with
Others:
Working the hyphen means creating occasions for
researchers and informants to discuss what is, and is
not, ‘happening between’, within the negotiated
relations of whose story is being told, why, to whom,
with what interpretation, and whose story is being
shadowed, why, for whom, and with what consequence
(Fine 1994, p. 72).
Fine (1994) is writing specifically about Self and Other
in qualitative research. However, her proposal is relevant to
all those who represent and interact with the Other:
It has been argued that the relationship between the
researcher and his subjects, by definition, resembles
that of the oppressor and the oppressed, because it is
the oppressor who defines the problem, the nature of
the research, and to some extent, the quality of
interaction between him and his subject (Fine 1994, p.
73).
If we compare this to the work of mental health profes-
sionals we recognize that they too may be oppressors and
researchers who have the specific task of defining the
oppressed as mentally ill and investigating their illnesses. In
viewing the relationship between nurse and patient as that
of Self and Other, we obscure the many relations between
the two and the quality of interaction is affected and
becomes inhibited.
Early in the century, ‘twas noble to write of the Other
for the purposes of what was considered knowledge.
Perhaps it still is. But now, much qualitative research is
undertaken for what may be a more terrifying aim – to
‘help’ them (Fine 1994, p. 79).
Church (1995), in her work with psychiatric survivors,
aimed to ‘help’ them. This involved her in ‘working the
hyphen’ (I have borrowed the term ‘working the hyphen’
from Fine 1994). In her exploration of the relationship
© 2002 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 9, 87–94
Othering and psychiatric nursing
between Self and Other, Church reached a point in her
work when she became neither professional nor survivor
and was in an uncomfortable place in between. Church had
to unlearn professional and academic ways of being and of
writing in order to relearn and, thereby, enable her to
‘work the hyphen’. She sees the need for the development
of specific practices ‘which would enable consumers/survi-
vors and mental health professionals to work together
across difference’ (Church 1995).
Church’s (1995) work involved her in relating to users
of psychiatric services as consumers and survivors. In aca-
demic literature, users are generally presented as patients.
This emphasizes their illness and obscures other aspects of
their being. They are objectified under the clinical gaze of
mental health professionals (Pilgrim & Rogers 1993).
From this position as objectified patients, users are denied
a voice. They are madness personified, the Other.
Conclusion
Othering intersects a number of disciplines, of which I have
only been able to study a few. The topic of Othering is so
broad that various disciplines are able to use it to relate to
the development of specific interests. Likewise, I have
embraced the topic of Othering in relation to my interest in
psychiatric nursing.
The problem of Othering is that it is oppressive and
results in misrepresentation of peoples. However, Othering
seems inevitable and, on reflection of Rosenhan’s study, all-
powerful. Othering, in relation to psychiatric nursing, may
appear to be simply the distinction between the ‘mad’ and
the ‘sane’; ‘them’ and ‘us’. However, in exploring Othering,
it has become apparent that it is more complex than ‘us’
and ‘them’ and that it is in fact an inevitability of nursing
practice and something of which nurses should be aware.
Walsh (1997) and Boyce (1998) illustrated the difficulties
posed by the problem of Othering in psychiatric nursing
practice. The work of Peplau, Tilley, Walsh, Fine and
Church offer suggestions to nurses such as ‘sharing com-
mon meanings’, ‘reality maintenance’, ‘working together
across difference’ and ‘working the hyphen’. These possible
solutions, discussed earlier, advocate bridging the gap
between the One and the Other and point to a place in
between where people can just ‘be’.
Acknowledgments
The author wishes to acknowledge the advice and feedback
on earlier drafts of this paper given by Dr Steve Tilley,
University of Edinburgh and Dr Allyson McCollam,
Scottish Development Centre for Mental Health.
93
E. J. MacCallum
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